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September 23, 2014 at 04:10 AM
The story The New York Times published over the weekend to rattle the U.S. health policy agenda was about a neck surgery patient who discovered charges from providers he had never heard of when he looked at his bills.
Elisabeth Rosenthal noted that many patients get bills from mystery providers who swoop in at the last minute to pig out on out-of-network payment gravy.
On the one hand: Hey, Elisabeth Rosenthal, welcome to the real world.
“Health policy groups,” “patient advocacy groups” and “consumer groups” in general seem to operate under the general assumption that insurance companies are heartless crooks and that doctors and hospitals are saintly.
But I think most of us who have entered a hospital for anything, even having a baby, in modern times, have discovered that, in practice, being a good health care consumer in a hospital is absolutely impossible. When I had a baby, I went to an in-network hospital, I had an in-network Ob/Gyn, and I had a printed list of anesthesiologists in the hospital who were in my network. I knew all about balance billing. I had interviewed all sorts of experts about balance billing. I had no more actual ability to avoid seeing out-of-network providers in the operating room than I had of flying out the window and circling the spire of the Empire State Building.
The only reason I avoided huge amounts of balance billing is that, for some reason, due to state law, provider-insurer negotiations, or provider niceness, the providers accepted the insurer’s views on what the reasonable and customary charges ought to be.
In another case, I went in for a simple checkup, ended up with a $400 sick visit bill, and got out of that bill only by carrying on in such a way that I’m a little afraid to ever get health care ever again.
